Even if you work in a fully staffed SNF and have the ability to spend an hour or more with each resident, the reality is, your residents are spending between 22 and 23 hours per day without you present. Subtract the time they spend sleeping, and they still have approximately 14 hours each day outside of therapy. So how can you ensure that your short time of influence actually results in a change in their function? One way is to collaborate with nursing staff to be sure your residents are completing their self care tasks with the same level of independence throughout the day, regardless of whether you are present.

I have had many times where a resident completes their morning ADLs during therapy with only a minimal level of assistance. I then come back later in the day to get a roommate or answer a call bell and find that same resident requiring maximal assistance from nursing staff for another easily relatable ADL task. Sometimes this is because the nursing staff were unaware as to how capable the resident truly is and how little assistance they require. Other times it is because the resident has opted not to divulge their capabilities and to instead allow nursing to complete tasks they are fully capable of doing themselves. But if practice improves function and inactivity delays progress, then how do you ensure that your residents continue to practice the skills they are learning in therapy so that they can discharge home sooner? One way is to ensure nursing staff—who are with residents for a far higher percentage of each day than occupational therapy staff—are aware of each resident’s abilities and performance on ADL tasks.

Interdisciplinary team meetings are a great way to share information with other members on the treatment team, so occupational therapists should be sure to briefly and accurately describe all progress the resident has made during IDT meetings so that other team members are aware. But IDT meetings often don’t occur frequently enough to capture progress for short stay residents, so it is also important to maintain open and frequent communication with nursing staff, particularly CNAs.

CNAs are generally very busy, but if you are completing ADLs with a particular resident one morning, chances are their CNA will have a few brief minutes to go over how things went before the session ends. If you’re able to have this debriefing in the resident’s room and with the resident present, then it’s even better because then the resident will also be aware of what you are sharing with nursing staff and can input their own thoughts and perspectives during the discussion. Be sure to share any adaptations or techniques you used to facilitate the resident’s maximal level of independence, as well as any sequencing or cueing that was necessary.

It is also important to continue to communicate with CNAs so that you are aware of how a resident is performing ADLs when you are not present. CNAs do ADLs with a resident far more frequently than occupational therapy staff, so they may notice trends that we can only speculate on. After you’ve discussed a particular resident’s ADL performance with a CNA, follow up a few days later to see how things are going. This will likely give you great insights into what to focus on during your next ADL session with the resident.

When collaborating with CNAs and other nursing staff, though, it is important to keep in mind that they are not therapists and that they have different and unique skills and training. So don’t tell a CNA something to do with a resident that would require the assistance and training of an occupational therapist or COTA to be accurately completed. Also, keep in mind that CNAs are busy and often overseeing multiple residents at once, so don’t recommend something that they can’t realistically and safely complete with a particular resident while still remaining available to address the needs of other residents as needed.

Interdisciplinary collaboration is an important tool in helping residents to achieve their maximal level of independence in a SNF and return to community living. As such, occupational therapists should make interdisciplinary collaboration with nursing staff a priority in order to ensure that the progress made during OT sessions is carried over into all self care sessions a resident completes each and every day.

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